New bundled pay model puts new limits on PAC providers

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Tumlinson: Doubts bundled pay participants will share savings with post-acute care partners.
Tumlinson: Doubts bundled pay participants will share savings with post-acute care partners.

Long-term care providers have had their wings clipped under terms of a new voluntary bundled pay model unveiled in mid-January.

The Bundled Payments for Care Improvement Advanced model relegates post-acute providers to secondary players when it comes to assuming risk or initiating episodes of care.

The new model includes 32 clinical episodes — down from 48 — ranging from joint replacements to coronary intervention. But post-acute organizations can participate only through financial partner- ships with other providers in the new version.

“This initiative effectively sunsets the SNF setting as the location for initiating an episode and taking risk as a participating provider,” Anne Tumlinson, CEO of Anne Tumlinson Innovations told McKnight's. “That was the original BPCI Model 3, and a lot of providers are disappointed that they won't have the opportunity to continue in that role.”

Bundled payment participants still can share savings with post-acute care partners, but it hasn't often happened in the original models.

“I would bet (it) won't happen this time around,” Tumlinson offered. “There's nothing to prevent SNFs from being conveners, if they can sign up hospitals and/or physicians as partners.”

The Centers for Medicare & Medicaid Services Center for Medicare and Medicaid Innovation announced the BPCI Advanced model on Jan. 9.

The new bundle program will start in October and run through Dec. 31, 2023, with each episode reviewed for inclusion annually starting in 2020. Applications must be submitted by March 12.

Participants can choose which episodes they want to bundle care for, but they are then locked in until 2020.